Take a Modular Approach to SnoMed-CT and ICD-10 Clinical Coding

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In a new blog post, Dr. John Halamka discusses ideas to improve clinical coding documentation in 2013 ahead of ICD-10, which will arrive on October 1, 2014. In order to improve the extraction of data from clinical charts, Halamka suggests doing away with the patchwork approach of multiple transcriptions, typed, dictated, and template information, and progress notes copied and handed off again and again. Instead, he imagines a jointly authored care note for each patient using a crowd-sourcing application inspired by Wikipedia and Facebook communication, which incorporates SNOMED-CT and ICD-10 in a module structure.

Using a cloud hosted structure of five distinct modules, Halamka envisions a collaborative EHR chart where every person involved in patient care has the opportunity to contribute to a daily note. Data is captured using disease specific templates “to ensure appropriate quality indicators are recorded.” Then, at the end of the day, the primary care physician signs off on the document, and the note is locked. “Gone are the “chart wars”, redundant statements, and miscommunication among team members,” Halamka says.  “As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code.”

Each module may be provided by a different company, focusing on the areas of disease specific templates, technology to capture free text, natural language processing to codify SNOMED-CT concepts, the mapping of SNOMED-CT to ICD-10 codes, and rules to ensure that the documentation is complete enough to justify the ICD-10 codes for billing. All five modules will work together to interface with EHR systems, although Halamka notes that getting vendors on board with the concept – and convincing CMS and malpractice insurers to accept jointly authored notes – may be challenging.

However, early adopters such as Kaiser Permanente, Geisinger, and Mayo are already working on elements of the approach. Halamka is optimistic that progress on the idea can be made in the 22 months until ICD-10 comes into effect, and welcomes comments and suggestions about the project.

Source: www.ehrintelligence.com; Jennifer Bresnick; December 18, 2012.

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